Crohn's Disease-Causes, Treatment and Research

Crohn's Disease, Cause and Treatments, Diet, Food, Supplements
ZHION.COM July 2011 Send your comment to zhion@zhion.com

What is Crohn's Disease?
Crohn's disease is an inflammatory bowel disease (IBD), the general name for diseases that
cause inflammation in the intestines. Crohn's disease can be difficult to diagnose because its
symptoms are similar to other intestinal disorders such as irritable bowel syndrome and to
another type of IBD called ulcerative colitis. Ulcerative colitis causes inflammation and ulcers in
the top layer of the lining of the large intestine.

Crohn's disease affects men and women equally and seems to run in some families. About 20
percent of people with Crohn's disease have a blood relative with some form of IBD, most often
a brother or sister and sometimes a parent or child.

Crohn's disease may also be called ileitis or enteritis.

What causes Crohn's disease?
Theories about what causes Crohn's disease abound, but none has been proven. The most
popular theory is that the body's immune system reacts to a virus or a bacterium by causing
ongoing inflammation in the intestine.

People with Crohn's disease tend to have abnormalities of the immune system, but doctors do
not know whether these abnormalities are a cause or result of the disease. Crohn's disease is
not caused by emotional distress.

What are the symptoms?
The most common symptoms of Crohn's disease are abdominal pain, often in the lower right
area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be
serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed
development and stunted growth.

How is Crohn's disease diagnosed?
A thorough physical exam and a series of tests may be required to diagnose Crohn's disease.

Blood tests may be done to check for anemia, which could indicate bleeding in the intestines.
Blood tests may also uncover a high white blood cell count, which is a sign of inflammation
somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or
infection in the intestines.

The doctor may do an upper gastrointestinal (GI) series to look at the small intestine. For this
test, the patient drinks barium, a chalky solution that coats the lining of the small intestine,
before x rays are taken. The barium shows up white on x-ray film, revealing inflammation or
other abnormalities in the intestine.

The doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope-a long,
flexible, lighted tube linked to a computer and TV monitor into the anus to see the inside of the
large intestine. The doctor will be able to see any inflammation or bleeding. During the exam,
the doctor may do a biopsy.

What are the complications of Crohn's disease?
The most common complication is blockage of the intestine. Blockage occurs because the
disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the
passage. Crohn's disease may also cause sores, or ulcers, that tunnel through the affected
area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus
and rectum are often involved. The tunnels, called fistulas, are a common complication and
often become infected.

Nutritional complications are common in Crohn's disease. Deficiencies of proteins, calories,
and vitamins are well documented in Crohn's disease. These deficiencies may be caused by
inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption).

Other complications associated with Crohn's disease include arthritis, skin problems,
inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and
biliary system. Some of these problems resolve during treatment for disease in the digestive
system, but some must be treated separately.

What is the treatment for Crohn's disease?
Treatment for Crohn's disease depends on the location and severity of disease, complications,
and response to previous treatment. The goals of treatment are to control inflammation, correct
nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal
bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of
these options. At this time, treatment can help control the disease, but there is no cure.

Some people have long periods of remission, sometimes years, when they are free of
symptoms. However, the disease usually recurs at various times over a person's lifetime.

Drug Therapy
Most people are first treated with drugs containing mesalamine, a substance that helps control
inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not
benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs,
generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side
effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and
headache.

Some patients take corticosteroids to control inflammation. These drugs are the most effective
for active Crohn's disease, but they can cause serious side effects, including greater
susceptibility to infection.

Drugs that suppress the immune system are also used to treat Crohn's disease. Most
commonly prescribed are 6-mercaptopurine and a related drug, azathioprine.
Immunosuppressive agents work by blocking the immune reaction that contributes to
inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may
lower a person's resistance to infection. When patients are treated with a combination of
corticosteroids and immunosuppressive drugs, the dose of corticosteriods can eventually be
lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness
of corticosteroids.

The U.S. Food and Drug Administration has approved the drug infliximab (brand name,
Remicade) for the treatment of moderate to severe Crohn's disease that does not respond to
standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and
for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically
for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a protein
produced by the immune system that may cause the inflammation associated with Crohn's
disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thereby
preventing inflammation. Investigators will continue to study patients taking infliximab to
determine its long-term safety and efficacy.

Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture,
fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of
the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but
additional medication may also be necessary. Several antidiarrheal agents could be used,
including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of
diarrhea will be treated with fluids and electrolytes.

Other potential choices include interleukin 10 (IL-10), budesonide, methotrexate, cyclosporine,
zinc and natalizumab. One must discuss with his or her doctor to see if they are available in
market and if they are appropriate for their conditions.

Nutrition, Supplements and Herbs that may be beneficial
The doctor may recommend nutritional supplements, especially for children whose growth has
been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A
small number of patients may need periods of feeding by vein. This can help patients who need
extra nutrition temporarily, those whose intestines need to rest, or those whose intestines
cannot absorb enough nutrition from food.

There are limited studies for using supplements or herbs for Crohn's disease. It is not sure if
there are not herbs or supplements offering benefits for patients suffered from Crohn's disease.
However, some marketers promote curcumin, fish oils, probiotics and vitamin D as a support
for the patients.

Surgery
Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The
inflammation tends to return next to the area of intestine that has been removed.

Some people who have Crohn's disease in the large intestine need to have their entire colon
removed in an operation called colectomy. A small opening is made in the front of the
abdominal wall, and the tip of the ileum is brought to the skin's surface. This opening, called a
stoma, is where waste exits the body.

Sometimes only the diseased section of intestine is removed and no stoma is needed. In this
operation, the intestine is cut above and below the diseased area and reconnected.

Because Crohn's disease often recurs after surgery, people considering it should carefully
weigh its benefits and risks compared with other treatments. However, some people with
Crohn's disease may feel well and be free of symptoms for substantial spans of time when their
disease is not active. Despite the need to take medication for long periods of time and
occasional hospitalizations, most people with Crohn's disease are able to hold jobs, raise
families, and function successfully at home and in society.

Can diet control Crohn's disease?
No special diet has been proven effective for preventing or treating this disease. Some people
find their symptoms are made worse by milk, alcohol, hot spices, or fiber. People are
encouraged to follow a nutritious diet and avoid any foods that seem to worsen symptoms. But
there are no consistent rules.

People should take vitamin supplements only on their doctor's advice.

Is pregnancy safe for women with Crohn's disease?
Research has shown that the course of pregnancy and delivery is usually not impaired in
women with Crohn's disease. Women with Crohn's disease should discuss the matter with their
doctors before pregnancy.

Reference Crohn's Disease NIH Publication No. 03-3410 January 2003

Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in
the lower part of the small intestine, called the ileum, but it can affect any part of the digestive
tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected
organ. The inflammation can cause pain and can make the intestines empty frequently, resulting
in diarrhea.